Barriers to Care

The Department of Defense (DoD) strives to better understand the barriers to care that service members face regarding mental health diagnoses and treatment. Seeking care early can help service members address mental health conditions in a timely manner, increase their psychological health literacy, improve their understanding of the Military Health System, and dispel myths regarding seeking mental health care. Despite the benefits of seeking mental health care, approximately 40-60% of military personnel who experience mental health problems do not seek mental health services [ Reference 1 ]; the underutilization of these services may be ascribed to barriers to mental health care related to:

Click on the buttons below to learn more about barriers to care.

Individual

Barriers related to the individual

The lack of perceived need for mental health treatment and the preference for self-management (i.e., use of other stress coping strategies) among service members may have contributed to the underutilization of mental health services [ Reference 2 ]. The 2011 Health Related Behaviors Survey of Active Duty Military Personnel, the largest anonymous survey that gathers data on some of the most important behavioral health issues affecting the well-being of the U.S. military, noted that in the previous 12 months, service members used coping strategies such as:

Social Networks

Barriers related to social networks

Service members have reported that their social networks significantly impact their decision to seek mental health care [ Reference 2 ]. Social factors that may hinder service members from seeking mental health care include:

Family, Friends and Peers

Concerns about being labeled and socially isolated; fear of public disclosure of and reactions to mental health problems and treatment-seeking; and the apprehension of being viewed as a burden by their family and friends, due to negative attitudes about people with mental health disorders and mental health care, can potentially deter service members from seeking mental health care [ Reference 3 ].

Military Peers and Leaders

Service members have reported that the fear of being treated differently and negatively viewed by leaders and units has adversely impacted their decision to seek mental health care. Additionally, concerns about career, public disclosure of mental health problems, public reactions to treatment-seeking, unfavorable labels, and social isolation and distance have also contributed to their decisions to avoid mental health services [ Reference 2 ].

Treatment

Barriers related to treatment

Factors that may impede service members from obtaining the treatment they need, or may contribute to treatment drop out include:

Institutional barriers

Institutional barriers are displayed in the intended and unintended discrimination toward people with a mental health diagnoses that manifests in a range of DoD and service-specific policies [ Reference 3 ]. In the 2014 report titled, “Mental Health Stigma in the Military,” RAND Corporation identified ways that DoD policies can potentially increase barriers to care, including mental health care stigma, in the military [ Reference 3 ][ Reference 5 ]:

Reduces people with a mental health diagnoses to a label (e.g., “mentally ill person”, “a psychotic,” or “a schizophrenic”)

Stigma

Stigma

Mental health care stigma in the military context is unique due to the military’s emphasis of certain qualities in service members (e.g., stoicism, strength, independence); service members often believe that seeking mental health care can hinder their ability to embody these qualities.

Mental health stigma is a dynamic process by which a service member perceives or internalizes this brand or marked identity about himself or herself or people with mental health disorders [ Reference 3 ].

While research indicates that mental health care stigma remains a significant concern for service members, particularly those in need of mental health treatment, there are mixed findings about how it impacts treatment seeking or mental health service use [ Reference 3 ][ Reference 4 ].

Rates of perceived stigma among service members have consistently been problematic. In response, DoD has sustained efforts to reduce mental health stigma including campaigns and programs [ Reference 3 ].

Mental Health Stigma in Key Contexts

Mental health stigma has been linked to four key interrelated contexts: